| NPI | 1235678053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C018151) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NC C018151) |
| 101Y00000X Counselor | |
| 101YM0800X Counselor Mental Health | |
| 103T00000X Psychologist | |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2025-07-18 |